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Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) A 23 yrs old left-handed man suffered a 63,000 volt electric arc burn. They had 30% second degree and 10% first degree burns. At five months from injury, they started developing tingling in the thumb, index, and middle finger of the left hand. Grip strength on the right hand was 20kg and 5kg on the affected side. Two-point discrimination in the left hand was 6 mm. What is it and what tests would you do?

Dynamometer elbow strength and endurance testing after distal biceps reconstruction with allograft. McGee, et al. (2015) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Distal biceps repair - Allograft tendon This study assessed the strength and functional outcomes of distal biceps reconstruction using allograft tissue. A total of 10 patients with a mean age of 48 years underwent surgery with Achilles tendon (90%) and tibilialis anterior/gracilis (10%) allograft. Patients underwent elbow flexion and supination strength/endurance test at 13 to 81 months after surgery. Patients underwent isokinetic dynamometer testing at 60°/s for strength and 240°/s for endurance, as well as isometric strength testing for elbow flexion and forearm supination. Results showed that the operative limb achieved near-normal strength, with peak torque in flexion (92%) and supination (93%) of the unaffected side. Fatigue indices were comparable between limbs, indicating similar endurance performance. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, reconstructing the distal biceps using allograft tissue is a safe and effective approach. Strength deficit was less than 10% compared to the unaffected side , which is much better compared to the strength deficit you would have without a repair (25% to 30% deficit) . These findings are in line with previous research suggesting that distal biceps repair for full tears are usually beneficial in active people . URL : https://doi.org/10.1177/2325967115S00166 Abstract Objectives: The purpose of the current study is to investigate the functional strength outcomes of late distal biceps reconstruction using allograft tissue. Methods: Patients who underwent distal biceps reconstruction with allograft tissue between May 2007 and May 2013 were identified. Charts were retrospectively reviewed for post-operative complications, gross flexion and supination strength, and range of motion (ROM). Isokinetic strength and endurance in elbow flexion and forearm supination were measured in both arms. Tests were conducted using a dynamometer at 60o per second for isokinetic strength and 240o per second for endurance. Isometric strength testing was also measured for elbow flexion and forearm supination. Paired t tests were used for statistical analysis. Results: Ten patients with a mean age of 48 years (range 42 - 61 years) were included in the study. Distal biceps reconstruction was performed using an Achilles tendon allograft in 9 patients and a combination of tibialis anterior allograft and gracilis allograft in 1 patient. Of the reconstructions, 50% involved the dominant arm. Full ROM was observed in all patients at the time of their final follow up assessment. The mean follow- up for dynamometer strength testing was 34 months (range 13-81 months). No statistical differences were noted between data obtained from operative and contralateral extremities. The average peak torque of the operative limb (38.5± 5.9 Nm) was 91.7% of that of the contralateral limb (41.8±4.9 Nm) in flexion and 93.4% (operative, 5.7±1.3 Nm; contralateral, 6.1± 1.0 Nm) in supination. No significant differences were found in fatigue index between operative or contralateral limbs for flexion (operative, 34.1±17.1%; contralateral, 30.8±17.1%; p = 0.29) or supination (operative, 38.2±16.5%; contralateral, 42.1±11.9%; p = 0.65). . The only complication observed was a transient PIN palsy in one patient which resolved by 3 months post-operatively. All patients reported postoperative cosmetic deformity but found their gross appearance acceptable. Conclusion: Late reconstruction for chronic distal biceps rupture using allograft tissue is a safe and effective solution for symptomatic patients with functional demands in forearm supination and elbow flexion. Dynamometer testing shows near normal return of strength and endurance of both elbow flexion and supination following the procedure. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Augmented anterior capsular plication for Type II atraumatic anterior sternoclavicular joint instability refractory to non-operative treatment based on structural anatomic MRI findings. Tytherleigh, et al. (2025) Level of Evidence : 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : SCJ - Stabilisation This retrospective study assessed the outcomes following surgical stabilisation of the anterior sternoclavicular joint (SCJ). A total of 13 participants with atraumatic presentation of SCJ instability confirmed by MRI were included. Age ranged from 16 to 25 years old and the majority were female (9 participants). All participants had trialled a conservative management approach first. A capsular splitting and plication augmented with suture anchors was utilised in all the patients. The results showed that QuickDASH reduced from an average of 32 to 1 out of 100 at six months post-surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, capsular plication with augmentation may be useful in those patients reporting collar bone instability at the sternum. Participants numbers in this study were however small and surgical risks of affecting lungs or important vessels should be disclosed. Overall, this study offers a new surgical option for rare cases of atraumatic SCJ instability. If you are interested in other shoulder presentations that you might come across working in hand and upper limb rehabilitation, have a look at the entire collection! URL : https://doi.org/10.1016/j.jse.2025.06.003 Abstract Background: Atraumatic anterior sternoclavicular joint (SCJ) instability is attributable to a component of capsular laxity (Type II) and muscle sequencing (Type III). The majority of patients can be successfully treated by a specialist physiotherapy protocol. However, a small number of patients, despite adequate treatment, remain symptomatic due to a residual Type II capsular laxity component. We have undertaken an augmented anterior capsular plication (ACP) procedure for patients with residual Type II atraumatic SCJ instability, confirmed by MRI, refractory to adequate non-operative treatment. Materials & Methods: Between 2015 and 2021 all patients that underwent an ACP for atraumatic SCJ instability with no evidence of a ligamentous capsular injury on MRI scan and were refractory to adequate non-operative treatment were reviewed. Exclusion criteria were patients that had not undergone adequate non-operative treatment, with a ligamentous injury on MRI scan or had undergone previous surgery. The procedure was a modification of a previously described augmented capsular repair for traumatic anterior SCJ instability. It consisted of a suture plication of the anterior capsule protected by an InternalBrace (Arthrex, Naples, FL, USA) between the medial clavicle and sternum. Patient-reported outcomes were assessed at 6 months, 12 months and at final follow-up by the following scores: Rockwood SCJ, Oxford Shoulder Instability Score (OSIS) and Single Assessment Numeric Evaluation (SANE). Optional questions were asked about the patients’ preoperative and postoperative participation in extracurricular activities and sport. Survivorship was defined as no clinical failure, such as instability or recurrent dislocation, and no revision surgery. Results: A total of 13 patients who underwent an ACP and were available at final follow-up were included. The mean age at surgery was 20.5 years (16-25) and the mean follow-up was 46.5 months (25-75). At final follow-up the mean Quick-DASH score had dropped from 32.2 (22.7 – 40.9) to 0.9 (4.5 – 0), the mean Rockwood score had risen from 7.5 (6 – 9) to 15 and the mean OSIS score had risen from 24.8 (18 – 31) to 47.5 (46 – 48). These all reached statistical significance. The mean SANE score at final follow-up was 95.5 (89 – 100). With regards to return to sport and extracurricular activities all of the patients considered their SCJ to be either “normal” (11 Patients) or to have “minor difficulties”. The repair/construct survivorship was 100%. Conclusion: Undertaking an augmented capsular plication on patients with symptomatic atraumatic SCJ instability confirmed by MRI imaging that have failed appropriate non-operative treatment provides a satisfactory result with regards to clinical outcomes and joint stability. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Patient perception of a community - based thumb osteoarthritis group: A qualitative service evaluation. Bamford, et al. (2025) Level of Evidence : 3a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Thumb OA - Community based group This service evaluation qualitative study assessed the value and reported experiences of people attending a community-based group for thumb osteoarthritis (OA). Two focus groups were completed to collect data. Participants highlighted the benefits of face to face interactions, practical advice on exercises, self-management strategies, and the social support provided by peers. They appreciated the biopsychosocial approach to managing their condition, acknowledging its complexity. However, challenges such as travel barriers, unclear referral pathways, and potential language inequities were noted. The study suggests that while the group intervention is well-received, improvements in access and equity are essential. Image from Duong et al. (2021) - https://www.handyevidence.com/post/is-mcpj-hyperextension-during-pinching-associated-with-greater-pain-in-thumb-oa Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, community groups for thumb OA are well received, particularly due to their holistic biopsychosocial approach. Participants valued face-to-face interactions and peer support. However, challenges such as travel barriers, unclear referral pathways, and language inequities can be problematic. If we were to implement this idea, we should integrate international guidelines alongside more recent evidence on the effectiveness of exercises and splinting , similarly to what the authors of this study have done. If you are interested in additional option for thumb OA such as resistance training or surgery, have a look at the database on the topic . URL : https://doi.org/10.1177/17589983251356917 Abstract Introduction: Base of thumb osteoarthritis (OA) is a common degenerative condition, causing pain, stiffness, weakness and functional limitations. Most patients initially present to their GP. It is important that patients have timely access to therapy interventions. A base of thumb OA group was established within a U.K. inner-city location, as part of a community musculoskeletal therapy service. The group aligned with international clinical guidelines, providing a treatment package including exercise, educational advice and behaviour change strategies. Methods: A prospective qualitative service evaluation was undertaken, with an aim of understanding patients’ experiences and views about the base of thumb OA group. Focus groups were undertaken with six patient participants and were recorded, transcribed and analysed thematically. Results: Participants were positive about the impact of the group on self-management of their condition. Participants recognised the complex nature of base of thumb OA and felt that the group provided holistic support. Participants expressed a need for long term support. From a practical perspective participants described some lack of clarity regarding the clinical pathway and referral routes and a lack of support during the waiting period. Participants expressed a preference for face-to-face care delivery. Discussion: Participants appeared supportive of the base of thumb OA group. It appears that such groups can be delivered in a community setting. Some practical service design and delivery lessons were learned. Further research would expand this relatively small scale, pragmatic service evaluation. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Is the anconeus epitrochlearis muscle a predictor for ulnar nerve compression?. Debras, et al. (2025) Level of Evidence : 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic : Anconeous epitrochlearis - Cubital tunnel syndrome. This retrospective study assessed the prevalence of the anconeus epitrochlearis (AE) muscle and its impact on cubital tunnel syndrome. A total of 1,240 participants who had undergone elbow MRI, were included in the study. A further 344 participants who had undergone ulnar nerve surgery were included. The results showed that AE was present in 5.9% of people undergoing an MRI. The presence of AE was not associated with an increased risk of ulnar nerve compression or subluxation, nor did it influence surgical outcomes or recovery time. Both groups, with and without AE, demonstrated similar rates of symptom resolution postoperatively. However, the study noted that preoperative nerve status, particularly hypoesthesia compared to paresthesia, was a significant predictor of surgical success. The findings suggest that the AE does not predispose individuals to cubital tunnel syndrome or negatively impact treatment outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, anconeus epitrochlearis (AE) is present in 6% of individuals or roughly in 1 out of 20 people we see. The presence of the AE is not associated with an increased risk of ulnar nerve compression or subluxation. Following cubital tunnel release, those with and without AE experienced similar rates of symptom resolution postoperatively. These findings appear to be in contrast with a previous study showing a higher prevalence of AE (1 in 10 people with cubital tunnel syndrome), although their sample size was 60% of the current study . URL : https://doi.org/10.1016/j.jse.2024.09.039 Abstract Background: The role of the anconeus epitrochlearis (AE) in cubital tunnel syndrome, either as protector or potential compressor of the ulnar nerve, as well as its prevalence in both symptomatic and asymptomatic patients is still unclear. This study aimed to assess the prevalence of the AE in a large cohort using 3-dimensional imaging and to investigate any association of the AE with preoperative or postoperative features of patients undergoing cubital tunnel surgery. Methods: From a database of 1240 elbow magnetic resonance imagings, all patients with an AE were retrospectively screened for major criteria of cubital tunnel syndrome. A matching cohort without AE was then similarly assessed to deduct the prevalence of AE and evaluate potential correlations. Next, 344 ulnar nerve surgeries were reviewed. Data including pre- and postoperative physical exam findings, electromyographic study results, reason for compression or (sub)luxation, presence of AE, time to improvement, and need for reoperations were collected. The prevalence of AE in the symptomatic population was determined and possible associations were explored. Results: The overall prevalence of AE in the population, based on magnetic resonance imaging data, was 5.9%, which closely matched the 5.8% prevalence observed in the operative population. Among the AE group of 13 patients, all were treated with myotomy and in situ decompression during surgery. No higher reoperation rate was seen in the AE group compared to the non-AE group. Conclusion: The contribution of the AE to the compression neuropathy or protection of the ulnar nerve could not be discerned for the standard population. Therefore, in the routine practice, the AE should be considered as a rare and nonpathological anatomical variant, devoid of any surgical implications. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow: A Systematic Review. Fares, et al. (2022) Level of Evidence: 3a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : LUCL reconstruction - Success This systematic review assessed outcomes following lateral ulnar collateral ligament (LUCL) reconstruction for postero-lateral rotatory instability of the elbow (PLRI). Eleven case series for a total of 148 participants were included in the review. The results showed that LUCL reconstruction consistently achieves lateral elbow stability and reduces pain, with most patients achieving postoperative stability (90%) and a mean Mayo Elbow Performance Score (MEPS - 0 to 100 with higher score representing better outcomes) of 89.7 at long-term follow-up. Graft selection varies, with the palmaris longus tendon being the most frequently used (45%), followed by triceps tendon (24%) and synthetic grafts (7%). Complications include persistent moderate to severe pain in 11% of patients and recurrent instability leading to reoperation in 2.7%. Picture from Rotaman et al. (2023) - https://www.handyevidence.com/post/how-much-does-the-posterolateral-ligament-of-the-elbow-contribute-to-stability Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Base on what we know today, 9 out of 10 people achieved elbow stability and good functional recovery following LUCL repair. Complications include persistent pain (1 in 10 people) and reoperations (3%). This suggests that despite this surgery being succesful, we should counsel patients on potential postoperative complications . LUCL reconstruction appears to be beneficial for young, active individuals requiring high elbow stability. If you want to know more about the important anatomy of the LUCL, have a look at the entire database . URL : https://doi.org/10.1177/1558944720917763 Abstract Background: Posterolateral rotatory instability (PLRI) is a common form of recurrent elbow instability. The aim of this systematic review is to present the outcomes and complications of lateral ulnar collateral ligament (LUCL) reconstruction surgery for PLRI. Methods: A literature search of LUCL reconstructions was performed, identifying 99 potential papers; 11 of which met inclusion/exclusion criteria, accounting for 148 patients. Papers were included if they reviewed cases of PLRI from 1976 to 2016 with reported outcome measures. Data were pooled and analyzed focusing on patient demographics as well as subjective and objective patient outcomes and complications. Results: The average age of patients was 34 years with a mean follow-up time of 49.8 months. The most common mechanism of injury was a traumatic elbow dislocation (66%), followed by cubitus varus deformity (7%), and unknown mechanisms (7%). Overall, 90% of patients achieved elbow stability and 2.7% experienced a failed reconstruction that necessitated an additional surgery. Furthermore, 93% were satisfied with the outcome of the reconstruction, and 83% reported good to excellent outcomes with 11% reporting moderate to severe persistent pain. Nearly half (45%) of reconstructions were done using a palmaris longus tendon graft, 24% with a triceps tendon graft, and 7% with a synthetic graft. Conclusions: Outcomes following LUCL reconstruction for PLRI are excellent and revision rates are low. LUCL reconstruction is a safe and reliable procedure. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Assessing long-term outcomes after operative management of elbow stiffness secondary to heterotopic ossification. Liu, et al. (2025) Level of Evidence : 3a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Heterotopic ossification - Excision This retrospective study assessed the long-term outcomes of elbow heterotopic ossification (HO) excision. A total of 48 participants were included in the present study. Pre-surgical range of movement for elbow in e/f and supination/pronation was 50 deg (range 10-75) and 80 deg (range 10-135) respectively. Following surgery, elbow e/f and supination/pronation reached 110 deg (range 95-130 deg) and 170 deg (range 105-180 deg) respectively. There was therefore a 60 deg arc of motion improvement for e/f and 90 deg arc of motion improvement for supination/pronation. Pain post surgery (Visual Analog Scale - VAS) ranged from 0 to 4 with a median of 2/10. Complications occurred in 15 patients (28%), including 5 people requiring a total elbow arthroplasty and others requiring additional surgery for elbow instability, stiffness, or ulnar nerve entrapment. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, heterotopic ossification excision improves range of motion and functional outcomes for most patients. On average the arc of motion improvement is 60 deg for extension/flexion and 90 deg for supination/pronation. It is important to remind patients that it is unlikely they will regain full range of motion and that there is a potential for complications requiring further surgery or even a total elbow replacement . Further education is also important on what to expect if people present with cubital tunnel syndrome and require a release . URL : https://doi.org/10.1016/j.jse.2024.11.019 Abstract Background: Heterotopic ossification (HO) of the elbow resulting in limited motion is a relatively uncommon condition often caused by burns, trauma, and central nervous system injuries. This retrospective study presents the long-term outcomes of 51 cases of elbow HO treated with surgical excision and regimented postoperative rehabilitation protocol. Methods: A retrospective case series was conducted on 48 patients (51 elbows) who underwent surgical excision of elbow HO. All procedures were performed in the inpatient setting at an Academic Level I Trauma Center between September 1999 and August 2022 by fellowship-trained upper extremity surgeons. Patient demographics and case characteristics such as age, gender, mechanism of injury, and comorbidities were collected for comparison. Long-term follow-up examinations were elbow flexion-extension arcs, prono-supination arcs, Visual Analog Scale pain scores, and Mayo Elbow Performance Score. Results: Patients were followed for a minimum of 2 years with an average follow-up of 8 years (range, 2-24 years). The median flexion-extension arc at final follow-up was 110° (95°-130°), which was maintained at 85% of the intraoperative arc achieved. Prono-supination arc at final follow-up was 170° (105°-180°), which was maintained at 97% of intraoperative levels. The median reported Mayo Elbow Performance Score and Visual Analog Scale score were 80 (70-93) and 2 (0-4), respectively. Although it was not statistically significant, patients diagnosed with type II diabetes had the worst flexion-extension arcs at final follow-up and highest complication rates compared to other risk factors. Conclusion: Surgical excision coupled with HO prophylaxis and a regimented rehabilitation program resulted in a lasting improvement in functional outcomes for patients with elbow dysfunction secondary to HO at long-term follow-up. Overall, patients maintained substantial reductions in pain, improvement in elbow range of motion, and increased overall elbow function. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Biomechanical evaluation of physical examination tests for rotator cuff tears: A computer simulation study. Menze, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Rotator cuff tears - Objective tests This biomechanical simulation study assessed diagnostic shoulder tests for detecting rotator cuff (RC) tears using musculoskeletal modeling. The analysis identifies variations in biomechanical sensitivity among tests, with the Lift-off test being more sensitive than the Bear Hug test for anterior RC tears due its heavy reliance on subscapularis muscle. Conversely, the Jobe and Full-can tests show low sensitivity for detecting superior RC tears, as deltoid is the main muscle involved. The Hornblower test emerged as more effective test for assessing teres minor integrity in posterosuperior RC tears. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the lift-off test and the Hornblower test are useful in detecting subscapularis and teres minor lesion respectively. Have a look at a previous case study to see how you can differentiate rotator cuff tears from other hand pathologies in your patients . Make sure that you screen your patients who have had an upper limb trauma for these pathologies! URL : https://doi.org/10.1016/j.jse.2024.09.050 Abstract Background: Numerous physical diagnostic shoulder tests have been established to determine the presence of rotator cuff tears and to identify the affected muscles. However, reported sensitivities and specificities of these tests vary strongly. The aim of this study was to identify diagnostic postures that are biomechanically most sensitive in identifying rotator cuff lesions and compensation mechanisms. Methods: A musculoskeletal modeling study investigating muscle activity in healthy shoulders as well as in shoulders with anterior, superior, and posterosuperior rotator cuff tear patterns, was conducted. Muscle moment arms and muscle synergism for the Lift-off and Bear Hug tests, Jobe and Full-can tests, and Infraspinatus and Hornblower tests were compared for healthy and pathological models. Results: In a healthy model the Lift-off test showed significantly higher subscapularis activity compared to the Bear Hug test (P < .001). Teres minor and infraspinatus activity were threefold and twofold higher, in the Hornblower than the Infraspinatus test, respectively. In superior tests, supraspinatus activity was more than twofold lower than lateral deltoid activity and synergistic activity increase was smallest (Δ 1%-3% in deltoid). Activity increase was highest in posterosuperior tests for the teres minor with 66.4% activity increase in the Infraspinatus test (P < .001) and 81.3% increase in the Hornblower test (P < .001). Conclusions: The Lift-off test was significantly more sensitive in detecting subscapularis tears and the Hornblower test was more effective in assessing teres minor integrity in posterosuperior tears. Both, Jobe and Full-can tests demonstrated low biomechanical sensitivity in the detection of superior rotator cuff tears. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Time to recovery of radial nerve palsy after surgically treated humeral shaft fractures. Gomez, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Wrist drop - Natural recovery This retrospective study assessed the outcomes of radial nerve palsy in surgically treated humeral shaft fractures. A total of 471 participants underwent open reduction internal fixation for humeral shaft fractures, of these, 58 patients presented with radial nerve palsy. The first signs of motor recovery happened on average at 4 months from injury. By 9 months, 50% of people had fully motor recovery. By 12 to 18 months, 80% to 90% of people respectively had recovered full motor function. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, radial nerve palsy following humeral shaft fractures surgery recovers in the large majority of people (8 to 9 people out of 10) within 12 to 18 months. One in 2 people have full motor recovery by 9 months. The first signs of motor recovery tend to appear around the fourth month from injury. Similar recovery times have been reported following radial nerve grafting . If you are looking for a cool splint to improve function during recovery, have a look at this one . If you want to know more about radial nerve pathology in general, have a look at the whole database on the topic ! URL : https://doi.org/10.1016/j.jhsa.2024.11.024 Abstract Purpose: The purpose of this study was to report a timeframe for neurologic recovery of complete radial nerve palsies in patients with humeral shaft fractures treated with internal fixation. Methods: We retrospectively analyzed the data of patients who underwent surgical treatment of a humeral shaft fracture between 2016 and 2021 at a level I trauma center. Patients with complete sensory and motor radial nerve palsy were identified. The time elapsed until detection of the first clinical signs of neurologic recovery, and then until full function (M5 according British Medical Research Council scale) was measured. Results: Of 32 radial nerve palsies in 471 surgically treated humeral shaft fractures (6.8%), 17 were recorded at the time of injury and 15 were noted after surgery. Median patient age was 31.5 years (range, 19–58 years). Thirty patients recovered full motor function at a median time of 36 weeks (range, 6–83 weeks). Kaplan-Meier analyses showed that 90.6% of patients presented the first signs of nerve recovery in the initial 6 months of observation. At 12 and 18 months of follow-up, 84.3% and 94% of patients, respectively, had recovered full function of the hand and wrist. Conclusions: Surgically treated humeral shaft fractures associated with radial nerve palsies are expected to show signs of neurologic recovery during the first 6 months and should recover completely after 12 months of follow-up in almost all cases. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Association of ultrasound and electrodiagnostic studies in patients evaluated for ulnar neuropathy. Sheen, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Cubital tunnel syndrome - Ultrasound imaging for diagnosis This retrospective study investigated the correlation between nerve conduction studies (NCS) severity and ultrasound measurements of ulnar nerve cross-sectional area (CSA). A total of 1,043 participants were included in the study of which 403 presented with cubital tunnel syndrome as per NCS. The ulnar nerve cross sectional area was measured via ultrasound 2 cm distal from the medial epicondyle, at the medial epicondyle, and 2 cm proximal to the medial epicondyle. The results showed that there was a moderate positive correlation between the ulnar nerve cross-sectional area and the severity of cubital tunnel neuropathy on NCS (see graph below). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, ultrasound measurements of ulnar nerve cross-sectional area (CSA) are moderately correlated with cubital tunnel severity as indicated by NCS. This is in line with previous research showing that CSA measurement of the ulnar nerve can be utilised to diagnose cubital tunnel syndrom and that severity of the presentation can be inferred by CSA . Remember that US imaging can be utilised to diagnose not only cubital tunnel syndrome but also carpal tunnel syndrome . URL : https://doi.org/10.1016/j.jhsa.2024.12.004 Abstract Purpose: Our goal was to determine the association between the severity of electrodiagnostic (EDX) studies with the cross-sectional area (CSA) of the ulnar nerve at the cubital tunnel using diagnostic ultrasound. Based on our clinical experience, we hypothesized there would not be a positive correlation between the severity of EDX and ulnar nerve CSA. Methods: This was a retrospective analysis of patients 18 years or older evaluated from May 1, 2020, to June 31, 2021, referred for an upper limb EDX and neuromuscular ultrasound to evaluate for an upper limb neuropathy. History, physical examination, ultrasound imaging (ulnar nerve at elbow), and EDX were reviewed. Patients were excluded for age under 18 years or concomitant upper limb radiculopathy. Baseline sample characteristics were analyzed, including age, race, sex, ethnicity, body mass index (normal, overweight, obese, or morbid obesity), and smoking status. Results: Of 1,043 patients, there were more females than males (634 vs 409) with an average age (SD) of 54.0 (15.5). Most of the patients were White (863) compared to Black (113) and other races (67). The average CSA of the ulnar nerve at the elbow increased with increased severity based on EDX results. There was a significant association between increasing severity on EDX and the increased nerve CSA at the elbow. Conclusions: We found a positive association between the EDX severity and the CSA of the ulnar nerve on diagnostic ultrasound at the cubital tunnel. As the severity of ulnar neuropathy at the elbow increases, the CSA of the ulnar nerve correspondingly increases at the elbow. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The effect of area-level deprivation on the severity of cubital tunnel syndrome on presentation to a hand surgeon. Mwamba, et al. (2025) Level of Evidence: 4 factors Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Economic/Diagnostic Topic : Socioeconomic determinants of health - Cubital tunnel syndrome This retrospective study assessed whether socioeconomic factors influenced the presentation severity and management of cubital tunnel syndrome. A total of 406 participants with cubital tunnel syndrome were included in the present study. The area deprivation index was available for each patient. McGowan cubital tunnel grading was utilised to assess the medical notes review. Grade I was characterised by tingling in the ulnar nerve distribution at the hand, grade II as persistent tingling with no or mild atrophy, grade III as persistent tingling with severe atrophy of the ulnar innervate hand muscles. The results showed that patients from socioeconomically disadvantaged areas presented with more severe symptoms of cubital tunnel syndrome (see graph below). This is likely due to barriers such as limited access to healthcare services or financial constraints, leading individuals to delay seeking medical care until their symptoms become more pronounced. Despite these challenges, individuals from disadvantaged backgrounds are more likely to undergo diagnostic testing once they do seek care. The severity of their symptoms may prompt healthcare providers to order more comprehensive evaluations. Notably, there is no significant difference in surgical rates or treatment delays between disadvantaged and less deprived individuals. Nerve conduction studies were more often completed in people from areas of higher deprivation. The stage of cubital tunnel syndrome also tended to be worse in people with publich insurance. Ethnicity, race, or deprivation index were not associated with the delivery of surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, people from lower socio-economic areas present with more severe cubital tunnel syndrome to health professionals. Fortunately, once they are in the system, there are no disparities in the way that they are treated with greater care (e.g. higher number of nerve conduction studies) provided to people in greater need. These findings appear to be in line with previous research showing that insurance type matters in terms of presentation severity of cubital tunnel syndrome . It is our role as health professionals to increase the awareness of these presentations and try and make sure that even those people who are from less well off areas understand the importance of getting their symptoms attended to by a health professional . Remember that several tests are available to aid in the diagnosis of cubital tunnel, including small finger forced abduction test . URL : https://doi.org/10.1016/j.jhsa.2024.11.007 Abstract Purpose: Cubital tunnel syndrome (CuTS) is the second most common upper-extremity neuropathy and can cause debilitating symptoms. Patients presenting to care with severe CuTS can be left with permanent weakness and numbness despite treatment. The aim of this study was to examine the relationship between area-level deprivation and the severity of CuTS on presentation to a hand surgeon. Methods: We retrospectively identified 369 patients who were diagnosed with CuTS at a new patient visit between January 2017 and December 2021. We queried the electronic health record to assess the severity of CuTS using the McGowan grade. We used patient addresses to determine the national percentile of area-level deprivation for each patient. Bivariate analyses were used to determine if sociodemographic factors were associated with CuTS severity on presentation or rates of surgical intervention. Results: In bivariate analysis, patients with higher levels of area-level deprivation had more severe CuTS. Those who were older, were men, and had public insurance were also found to have more severe CuTS. Secondary analysis revealed that patients with higher levels of deprivation were more likely to receive nerve conduction testing. No sociodemographic factors were associated with whether patients received surgical intervention or in time from presentation to surgery. Conclusions: Patients from marginalized backgrounds present to hand surgeons with more severe CuTS disease. Clinical relevance: Delayed presentation can lead to worse outcomes in CuTS. Understanding barriers to earlier presentation in more deprived locations and certain patient populations can help develop solutions to address these disparities. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Acromial stress fractures and reactions after reverse total shoulder arthroplasty: A case-control study. Wiemer, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Diagnostic/Prognostic Topic : Stress fracture - Upper limb This retrospective study assessed the incidence and risk factors for acromial stress fractures following reverse total shoulder arthroplasty. A total of 220 participants who had undergone reverse shoulder replacement were included. X-rays, CT scans, and SPECT-CT scans were utilised to assess the presence of an acromial stress fracture. The results showed that around 10% of participants developed an acromial stress fractures. Risk factors for the presence of a stress fracture included oral corticosteroid use (for systemic disease e.g. rheumatoid arthritis), and a history of previous shoulder surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know, acromial stress fractures occur in 1 patient out of 10 following reverse shoulder replacement usually 5 months after surgery (range 1 month to 10 years after surgery). Those people who are more likely to develop this complication are those on oral cortisone for systemic condition or people who have had a previous shoulder surgery on the same side. Imaging for diagnosis would require a shoulder x-ray +/- CT or SPECT-CT scan. Management of these people is conservative and includes the use of a shoulder sling for 4-6 weeks. These findings appear to be in line with previous research in shoulder replacements suggesting that higher metabolic disease (e.g. obesity ) increase the risk of complications following upper limb surgeries . URL : https://doi.org/10.1016/j.jse.2024.11.035 Abstract Background: Acromial stress fractures can occur after reverse total shoulder arthroplasty (rTSA). We performed this study to assess the incidence, risk factors, characteristics, and outcome of acromial stress fractures and reactions after rTSA. Methods: We determined the incidence of acromial stress fractures and reactions in a cohort of patients who underwent rTSA, and assessed risk factors using a case-control design. Each patient who developed an acromial stress fracture or reaction after rTSA (case) was matched by date of rTSA with 2 patients who did not develop acromial stress fractures/reactions after rTSA (control subjects); univariate and multivariable analyses were performed to identify risk factors. Characteristics of acromial stress fractures/reactions are described. Outcomes were compared between cases and control subjects. Results: The incidence of acromial stress fracture/reaction after rTSA was 11% (24/220 rTSAs). Acromial stress fractures/reactions occurred at a median time of 5.5 months after rTSA (range: 20 days-118 months) and most were fractures (18/24, 75%). Using a multivariable analysis, we found 2 factors to be independently associated with the occurrence of an acromial stress fracture/reaction after rTSA: corticosteroids use (adjusted OR: 9.6, 95% confidence interval: 1.1-86.1, P = .04) and previous shoulder surgery (adjusted OR: 7.2, 95% confidence interval: 1.4-36.6, P = .02). In this cohort, in which the management was exclusively conservative, the occurrence of post-rTSA acromial stress fracture/reaction was associated with a significantly worse functional outcome at last follow-up visit, as compared with control subjects. This was illustrated by significantly lower American Shoulder and Elbow Surgeons Shoulder score, higher Shoulder Pain and Disability Index and Disabilities of the Arm, Shoulder and Hand scores, and worse forward elevation and internal rotation as compared with control patients who did not develop acromial stress fracture/reaction after rTSA. Conclusions: In our Australian cohort, acromial stress fractures/reactions were relatively common after rTSA, and independently associated with corticosteroids use and previous shoulder surgery. The occurrence of acromial stress fracture/reaction was associated with a significantly worse functional outcome, as compared with patients who do not develop this complication after rTSA. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings